Provider Demographics
NPI:1669403051
Name:INTERNAL MEDICINE PRACTICE ASSOCIATES PC
Entity type:Organization
Organization Name:INTERNAL MEDICINE PRACTICE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-880-5539
Mailing Address - Street 1:46090 LAKE CENTER PLZ
Mailing Address - Street 2:201
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5876
Mailing Address - Country:US
Mailing Address - Phone:703-444-6544
Mailing Address - Fax:703-444-1121
Practice Address - Street 1:46090 LAKE CENTER PLZ
Practice Address - Street 2:201
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5876
Practice Address - Country:US
Practice Address - Phone:703-444-6544
Practice Address - Fax:703-444-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF6585OtherMEDICARE RAILROAD
VAC09957Medicare PIN
DCG02542Medicare PIN